Provider Demographics
NPI:1225895782
Name:DENK, JENNIFER MATTHEWS (LMSW LCSW SUPERVISEE)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MATTHEWS
Last Name:DENK
Suffix:
Gender:F
Credentials:LMSW LCSW SUPERVISEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10351 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3583
Mailing Address - Country:US
Mailing Address - Phone:571-236-9093
Mailing Address - Fax:
Practice Address - Street 1:3953 PENDER DR STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-0970
Practice Address - Country:US
Practice Address - Phone:703-270-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09030031161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty